Orthopedic surgery in older patients: Outcomes data best predictor of risk

Baby boomers aren't just flooding the healthcare market to seek treatment for chronic conditions and age-related ailments. To the contrary, many fit and athletic seniors are banging down orthopedists' doors demanding to be surgically restored to their prime--or at least patched up enough so they don't have to give up a sport they've loved for decades.

In fact, between 2001 and 2008, the largest increase in the number of rotator cuff and knee surgeries was among patients over 61, according to the Agency for Healthcare Research and Quality. The steepest increase, jumping from 21 to 28 percent of all such surgeries during that time period, occurred among patients ages 61 to 70 who underwent arthroplasty to repair or replace ailing knees, notes the Boston Globe. During the same time, the percentage of patients under 40 receiving knee or rotator cuff surgeries declined.

For surgeons, this trend pulls them in two powerful directions, says Marshall K. Steele, MD, an orthopedic surgeon and founder of Marshall Steele & Associates, a firm specializing in orthopedic service line creation and transformation. "One is the demand for the elder patient to receive the care they would've when they were 30 or 40; and on the other side are physicians saying to themselves, 'Is this appropriate? Should I be doing this?'"

Indeed, historically, specialists have been reluctant to surgically repair sports injuries on older patients in part because the procedures carry a risk of complications, such as from anesthesia, for what are essentially elective procedures, Alan Curtis, MD, an orthopedic surgeon who specializes in sports medicine at Boston's New England Baptist Hospital, told the Globe. Older patients are more likely to have preexisting heart or lung problems, which can raise the risk of complications.

But Curtis, who recently agreed to repair an 85-year-old's rotator cuff and shortly thereafter received a photo of his patient returned to playing tennis, said, "You can treat these folks aggressively as long as they are medically OK to do so. Even in young people, the risk is never zero."

Physicians can arrive at more precise risk assessment, Steele says, by collecting data on patient-reported outcomes. In other words, how many octogenarian tennis players had surgery and returned to the court--30 or just the one? "If you haven't done a lot of surgery on older patients, you may not know exactly what to predict in terms of success for a particular surgery. But if you'd measured and collected outcomes, you'd be able to say, for instance, ‘You have a 50 percent chance of returning to your activity,'" Steele says. With this information available and transparent, patients and physicians will be better armed to determine the best course.

The other issue raised by all of these procedures is one of cost, Steele tells FiercePracticeManagement. "Doctors are going to have to work closely with hospitals to reduce costs and increase value--in all areas--to ensure we'll be able to provide all of the services that are in demand."

To learn more:
- read this piece in the Boston Globe